Association of preprocedural cardiac magnetic resonance imaging with outcomes of ventricular tachycardia ablation in patients with idiopathic dilated cardiomyopathy

Abstract

Knowledge of complex arrhythmogenic substrates can help plan ventricular tachycardia (VT) ablation in patients with idiopathic dilated cardiomyopathy (DCM). The purpose of this study was to assess whether preprocedural late gadolinium enhancement magnetic resonance imaging (LGE-MRI) can improve ablation outcomes in DCM. Consecutive patients (N = 96) with idiopathic DCM underwent VT ablation with open-irrigated catheters (2006-2016). Before 2012, LGE-MRI was not performed at our institution in patients with implanted devices, but it has been performed routinely in all patients after implementation of a new MRI protocol in 2012. We retrospectively compared acute and long-term outcomes of initial VT ablation procedures in patients with (n = 41) and those without (n = 55) preprocedural LGE-MRI. Procedural outcome was classified as successful if VT was not inducible postablation. The 2 groups had a similar mean age and ejection fraction, comorbidities, and frequency of epicardial ablation. Preablation LGE-MRI was independently associated with improved procedural success (63% vs 24%) by logistic regression analysis (adjusted odds ratio [OR] 7.86, P <.001). This result was consistent even when patients with nondiagnostic MRIs due to artifact were included in the imaging group (OR 4.87, P = .005). Preablation imaging was also associated with improved survival free of the composite endpoint of VT recurrence, heart transplantation, or death, which was met by 11 (27%) and 33 (60%) patients in the imaging and no imaging groups, respectively, after median 7.6 months of follow-up (unadjusted log-rank P = .02). However, there was no association with long-term outcomes after adjustment for other covariates. Preprocedural imaging with LGE-MRI may be associated with improved outcomes of VT ablation in DCM.